Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability and quality.”World Health Organization (2016), Global Strategy on Human Resources for Health
Human resources are an integral part of the health system, providing the link between the theoretical health services provision and the actual performance of the health service. The health workforce includes those who provide direct health services such as doctors and nurses and those who support the health services such as hospital managers, provincial and district managers, and accountants reporting on health budgets.
The health sector is not only labour-intensive, but it also depends on a precise application of the knowledge and skills of its workforce to ensure patient security and health. The mere availability of health workers is not sufficient; only when they are evenly distributed and accessible to the population, when they possess the required competencies, are motivated and empowered to deliver good-quality care, and when they are adequately supported by the health system does this translate into effective service coverage.
Many countries face difficulties in the education, deployment, retention and performance of their health workforce. In particular, many experience a high turnover of skilled health personnel because they migrate to countries offering better remuneration, better working conditions, opportunities for postgraduate education and training, and better standards of living. Ad hoc interventions consistently fail to correct workforce imbalances in health care. It takes years to educate and train health professionals and thus a long-term approach needs to be taken. Human resource decisions have long-lasting effects and are often difficult to reverse. This means that, rather than respond reactively, a strategic approach is needed that supports the development of a more resilient health system.
Improvements in community systems for health should likewise be considered alongside strategies to build capacities of the national health workforce. Community health workers are a critical channel for health service delivery to vulnerable and marginalized groups and for reaching communities disproportionately impacted by public health threats, including the COVID-19 pandemic. Learn more in the “Community systems strengthening” section.
UNDP works closely with the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to build national capacity to aim for sufficient staffing and skill levels; adequate structures, roles and responsibilities; plans for addressing human resource gaps; and effective staff retention and staff development strategies. This includes supporting ministries of health to:
UNDP also helps to leverage digital solutions and build capacities of ministries of health in the use of information and communications technology (ICT) as one way to improve the impact on human resources for health interventions. ICT investments can focus on software and systems to contribute to issues such as workforce planning, professional development and improving the working environment. Most notably, ICT can support the analysis of where health workers are most required, the development of e-learning modules to motivate and improve on-the-job learning, electronic health records improving links between health workers and patients, and improving morale, payroll management and performance management.
Strong policy frameworks are key to ensuring effective health workforces, by providing the political and strategic basis to plan, finance and implement priorities in the short, medium and long term. A strong national human resources for health policy can help to promote the availability of health workers in sufficient quantity and quality, at all levels and at the right place at the right time and ensure that they are well motivated to perform their functions. The goals of the human resources for health policy should be consistent with the broader national health objectives.
A human resources strategic plan should elaborate on what the policy will achieve and how it will be implemented and financed. It should follow from a comprehensive analysis of the human resources situation and challenges affecting the recruitment, development and retention of the health workforce. It is also important to consider that skilled health workers are unable to deliver services effectively without appropriate support personnel (accountants, information technology support officers, etc.) as well as physical capital such as adequate facilities, equipment and consumables such as medicines. Thus, health systems and the supporting human resources for health strategies need to balance these three vital demands – human resources, physical capital and consumables.
The World Health Organization (WHO) offers guidance and tools to support the situation analysis, planning, and policy-making processes to strengthen the planning and governance of human resources in the health sector.
UNDP has supported staff within national procurement agencies in both Sudan and Zimbabwe to gain international accredited qualifications to support their personal staff development and to lead to better procurement practices and systems. The Chartered Institute of Procurement & Supply (CIPS) accreditation is available at different levels, which allows staff to gain higher level qualifications as their careers progress. Staff development programmes such as these act as non-financial incentives to reduce staff turnover and increase retention, which is crucial for building national capacity.
Considerable progress has been made on tuberculosis (TB) in the Western Pacific region over the past few decades, but more work is needed to meet targets set out in global strategies aimed at bringing an end to the epidemic. The Nauru National Guidelines were developed by the Ministry of Health in partnership with the World Health Organization (WHO) and UNDP as an important tool for the national TB response. UNDP supported a refresher course on the guidelines through a national workshop for health workers, including medical doctors, nurses, clinicians and directly observed treatment workers, as part of the UNDP-managed Global Fund Multi-Country Western Pacific Integrated HIV/TB Programme. “Health workers play a central role in TB elimination – they are our frontline soldiers against this infectious disease,” said Dr Subhash Yadav, a technical expert at the WHO Pacific Office, who led the training. Dr Yadav further states that “Increasing our efforts to strengthen their capacity is essential if we are to achieve the targets of the End TB Strategy, including 90 percent reduction in TB deaths and an 80 percent reduction in TB incidence by 2030.” Read more
Local communities and volunteers play a vital role in supporting patients to stay on treatment. UNDP and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), through the Ministry of Health, are partnering with volunteers from the Tuvalu Red Cross to ensure people are supported during the often gruelling, but life-saving, treatment regime. UNDP also supported the recruitment of international United Nations volunteers to support the capacity-building of local volunteers, such as Dr Ronald Achidri from Uganda. “I support the Ministry of Health in the control of TB and HIV by working with and training community health workers, initiating and implementing preventive approaches, and treating patients,” explained Dr. Achidri. Read more
The Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) recognizes human resources as one of the key elements to creating resilient and sustainable health systems and that it can be a critical bottleneck to the scale-up and delivery of high quality health services. Most countries supported by the Global Fund face human resources challenges, including shortages and poor distribution, high turnover, inadequate skills, poor working conditions and a lack of appropriate health workforce information. In addition, human resources manage and make decisions about the use of all the other inputs to the health system. The Global Fund therefore prioritizes investments in human resources in funding applications, particularly when health workforce challenges represent a barrier to the availability, accessibility, acceptability or quality of services, most notably in countries with high disease burden and low economic status.
Find more guidance on the Global Fund’s support to human resources in this technical brief.
Global Strategy on Human Resources for Health: Workforce 2030
World Health Organization
Over 200 experts from all WHO regions contributed to consolidating the evidence around a comprehensive health labour market framework for universal health coverage.
Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention
World Health Organization
WHO Education and Training
World Health Organization